Healthcare Priority-Setting: Chat-Ting Is Not Enough; Comment on “Swiss-CHAT: Citizens Discuss Priorities for Swiss Health Insurance Coverage”

Document Type : Commentary


Center for Ethics, College of Human Medicine, Michigan State University, East Lansing, MI, USA


CHAT has its limits. It is a three-hour exercise. However, the real world problems of healthcare rationing and priority-setting are too complex for a three-hour exercise. What is needed, as a supplement, are sustained processes of rational democratic deliberation that can address the challenges to healthcare justice posed by costly emerging medical technologies, such as these targeted cancer therapies.


Main Subjects

  1. Hurst SA, Schindler M, Goold SD, Danis M.  Swiss-CHAT: citizens discuss priorities for Swiss health insurance coverage.  Int J Health Policy Manag. 2018;7(8):746-754. doi:10.15171/ijhpm.2018.15
  2. Davis C, Naci H, Gurpinar E, Poplavska E, Pinto A, Aggarwal A.  Availability of evidence of benefits on overall survival and quality of life of cancer drugs approved by European Medicine Agency: retrospective cohort study of drug approvals 2009-2013.  BMJ. 2017;359:j4530. doi:10.1136/bmj.j4530
  3. Schilsky RL, Schnipper LE.  Hans Christian Andersen and the value of new cancer treatments.  J Natl Cancer Inst. 2018;110 (5):441-442. doi:10.1093/jnci/djx261
  4. Bach PB, Giralt SA, Saltz LB.  FDA approval of tisagenlecleucel: promise and complexities of a $475000 cancer drug.  JAMA. 2017;318(19):1861-1862. doi:10.1001/jama.2017.15218
  5. Vivot A, Jacot J, Zeitoun JD, Ravaud P, Crequit P, Porcher R.  Clinical benefit, price, approval characteristics of FDA-approved new drugs for treating advanced solid cancer, 2000-2015.  Ann Oncol. 2017; 28(5):1111-1116. doi:10.1093/annonc/mdx053
  6. Triggle N.  Cancer drugs fund ‘huge waste of money.’  BBC News. April 28, 2017.  Accessed May 17, 2018.
  7. Blank C.  FDA approves breakthrough drug for HIV patients with dwindling options.  Modern Medicine Network: Formulary Watch.  March 13, 2018.
  8. Fleck LM.  Just Caring: Health Care Rationing and Democratic Deliberation. New York: Oxford University Press; 2009. 
  9. Rawls J.  Political Liberalism.  New York: Columbia University Press; 1996.